Typhoid Fever in Pi[jS. 475 



or less comple post mortem examination in six of tlie cases ; and it is 

 on the results thus obtained that the following observations are 

 based. 



The only strikingly characteristic morbid changes were seated in 

 the intestinal canal. These were in every sense remarkable. 

 Described in general terms, they may be said to consist of a series of 

 ulcerations of peculiar character, variously distributed over the intes- 

 tinal tract, from the stomach to the rectum inclusive. 



The first stage of the local afiection appears to be marked by the 

 development (amid all the phenomena of acute inflaimnatory dis- 

 turbance), in the substance of the mucous membrane and in the 

 submucous tissue, of an adventitious deposit (or cell-growth, rather), 

 resembling, in many of its characters, the v/ell-loiown yellow matter of 

 liumau typhoid fever. 



The seat of this new formation is marked by circular or oval 

 patches, varying in diameter from a quarter of an inch to two inches, 

 which attract the eye by their striking constrast in colom- to the sm*- 

 rounding membrane, and by their standing in relief upon it. (Figs, la, 

 p. 476, and Ih, p. 477.) 



The tinge of these patches varies from brownish yellow, through 

 chocolate, to deep violet. 



In a more advanced stage, the corresponding mucous membrane is 

 foimd fretted with numerous small ulcers, or has entirely disappeared 

 over the whole extent of tlie morbid deposit, which then forms the 

 base of the sore. These two extremes were well sho"vvn in two 

 stomachs taken from pigs which died at difierent stages of the disease. 

 (See Figs la, p. 476, and 2, p. 479.) 



In some specimens, the ulcers iiov/ appear in the form of deep exca- 

 vations. In the greater number, however, the idcerative process is 

 concurrent v/ith an exuberant outgrowth of the new formation already 

 described, and in such v/ise that the ulcerations present a series of 

 more or less fungoid elevations on the surface of the mucous membrane, 

 A similar tendency, but in slighter degree, is exhibited in certain 

 cases of typhoid fever in man. The resulting changes, in fact, form 

 the subject of one Cruveilhicr's most effective plates. In the j^ig, this 

 tendency to exuberant vegetative outgrov/th, in the cases which have 

 fallen under my obseiwation, reached its maximum in the stomach, as 

 may be seen by Fig. 2, p. 479. In this stomach, it will be observed, there 

 are five ulcers, varying in diameter from a third of an inch to about 

 an inch and a half. Like the ulcers generally, they are either circular 

 or oval in shape. These ulcers are not only raised much above the 

 level of the sm-rounding membrane, but are bounded by everted edges, 

 which project, mushroom-like, considerably beyond the base or pedicle 

 of the outgrowth. They resemble notliing so much — and the parallel 

 is in more than one way deeply suggestive — as a series of cancerous 

 ulcerations which I once sav/ in the colon of a woman who had died 

 of cancer of that gut and of the mesentery. The surface of these 

 ulcers was apparently in organic connexion with the vessels of the 

 j)art ; the morbid matter by which it v.'as constituted being of a deep 

 violet colour, from infiltration with blood. 



